Emergency

LIMB THREATENING LIFE THREATENING

Life saving before limb

saving
 A irway with cervical spine control

ATLS B reathing
C irculation with control of hemorrage
D isability (neurological state)
E xposure (take the patient clothes off)
 CLINICAL FEATURES
CLINICAL FEATURES
LOCAL SIGN
Look :
Any swelling, bruising, or deformity?
Is skin intact ?
How about posture of distal extremity ?
How about colour of skin ?
 LOCAL SIGN
CLINICAL FEATURES

Feel :
Palpate local tenderness ?
Any Associated injury ?
Any Vascular/Nerve abnormality ?
CLINICAL FEATURES

LOCAL SIGN
Move :
Abnormal movement
Crepitation
X-RAY
RULE oF TWO :
1. Two Views
2. Two Joints
3. Two Limbs
4. Two Injuries
5. Two Occasions
Gustillo Wound size
Level Contamination
Anderson Soft tissue Injury
Bone Injury
Classification Vascular Injury

of Open
Fracture
Grd I
Open Fracture grade 2
 Grd II
Open Fracture grade 1
Grd IIIA
Open Fracture grade 3A
Grd III B
Open Fracture grade 3B
Grd III C

Open Fracture
grade 3C
Principles of
treatment
ATS
Antibiotic prophylaxis
Wound irrigation
Debridement
Fractures stabilization
Early wound coverage
Antibiotic prophylaxis

OPEN FRACTURE
GRADE 1 : CEPHALOSPORIN generasi 1
GRADE 2 : CEPHALOSPORIN generasi 1

GRADE 3 : CEPHALOSPORIN generasi 1

+ AMINOGLYCOSIDE
FARM INJURY + PENICCILIN PROCAIN
Not proper initial management
TERIMA
KASIH